Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT 06519, USA.
Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT 06519, USA.
Am J Emerg Med. 2021 Feb;40:169-172. doi: 10.1016/j.ajem.2020.10.058. Epub 2020 Nov 13.
Emergency Department (ED) boarding, the practice of holding patients in the ED after they have been admitted to the hospital due to unavailability of inpatient beds, is common and contributes to the public health crisis of ED crowding. Prior work has documented the harms of ED boarding on access and quality of care. Limited studies examine the relationship between ED boarding and an equally important domain of quality-the cost of care. This study evaluates the relationship between ED boarding, ED characteristics and risk-adjusted hospitalization costs utilizing national publicly-reported measures.
We conducted a cross-sectional analysis of two 2018 Centers for Medicare and Medicaid Services (CMS) Hospital Compare datasets: 1) Medicare Hospital Spending per Patient and 2) Timely and Effective Care. We constructed a hospital-level multivariate linear regression analysis to examine the association between ED boarding and Medicare spending per beneficiary (MSPB), adjusting for ED length of stay, door to diagnostic evaluation time, and ED patient volume.
A total of 2903 hospitals were included in the analysis. ED boarding was significantly correlated with MSPB (r = 0.1774; p-value: < 0.0001). In multivariate regression, ED boarding was also positively associated with MSPB (Beta: 0.00015; p < 0.0001) after adjustment for other hospital level crowding indicators.
We found a strong relationship between measures of ED crowding, including ED boarding, and risk-adjusted hospital spending. Future work should elucidate the mediators of this relationship. Policymakers and administrators should consider the financial harms of ED boarding when devising strategies to improve hospital care access and flow.
由于住院床位不足，将患者收入医院后在急诊部（ED）滞留的做法（即 ED 留观）很常见，这也是造成 ED 拥堵这一公共卫生危机的原因之一。先前的研究已经记录了 ED 留观对获得医疗服务和医疗质量的危害。但仅有有限的研究考察了 ED 留观与医疗质量的另一个同等重要的领域（即医疗成本）之间的关系。本研究利用全国公开报告的衡量标准评估了 ED 留观、ED 特征与经风险调整的住院费用之间的关系。
我们对 2018 年医疗保险和医疗补助服务中心（CMS）的两个医院比较数据集进行了横断面分析：1）每位患者的 Medicare 医院支出；2）及时有效的护理。我们构建了一个医院层面的多元线性回归分析，以检验 ED 留观与每位受益人的 Medicare 支出（MSPB）之间的关联，同时调整 ED 住院时间、从进入 ED 到接受诊断评估的时间以及 ED 患者量等因素。
共有 2903 家医院纳入分析。ED 留观与 MSPB 显著相关（r = 0.1774；p 值<0.0001）。在多元回归分析中，ED 留观在调整其他医院拥挤指标后，与 MSPB 呈正相关（Beta：0.00015；p < 0.0001）。
我们发现 ED 拥挤的衡量指标，包括 ED 留观，与经风险调整的医院支出之间存在很强的关系。未来的研究应该阐明这种关系的中介因素。政策制定者和管理者在制定改善医院获得医疗服务和流程的策略时，应考虑 ED 留观造成的财务危害。
